Teladoc - Home | Trustmark



TeladocOverviewTeladoc is a vendor that offers telemedicine services through a network of board-certified physicians who treat acute, non-emergency medical conditions via telephone or video consultations. With Teladoc the member can: Resolve medical issues by working with doctors who are able to diagnose, treat and prescribe medications, when appropriateSpeak to a U.S. board-certified doctor any time of day, from anywhere (home, work, vacation, school, business trip, etc.)Have consultation results shared with the member’s primary care physicianReceive cost savings vs. with other providers ($45 per consultation)Effective DateNovember 1, 2016 – consultation fee changed from $40 to $45July 1, 2015 (new plans and renewing plans on or after July 1, 2015)Products AffectedAll Starmark Plans are provided with this automatic coverage (not optional)Healthy ChoicesHealthy EdgeHealthy IncentivesPreventive Plus (MEC)AvailabilityTeladoc services are available to members and their eligible dependents in all 50 states, except groups located in and members residing in Arkansas. The Teladoc services consist of telephone and video consultations, which are available in most states; however, some states allow only phone consults. Phone consults are available 24/7/365; while video consults are available 7 a.m. - 9 p.m., 365 days a year.How Teladoc WorksEligible members will be provided with information to allow them to register for Teladoc services and schedule appointments. Teladoc will bill the member and send the claim to Starmark.The most commonly treated conditions include:AllergiesBronchitisCoughEar InfectionFluNasal CongestionPink EyeRespiratory InfectionSinus ProblemsUrinary Tract Infection (UTI)Following is a general flow of how Teladoc works.A weekly mail file of renewing groups is sent to Teladoc every Monday.A welcome kit, which includes a description of the services and a wallet card, is sent to the eligible member. Teladoc will use Real Time Eligibility (RTE) to get data on eligible members.Note: Teladoc receives Real Time Eligibility (RTE) to assure accurate eligibility and available benefits (including out-of-pocket information) at the time of the consult.The eligible member registers by contacting Teladoc via telephone or online by setting up an account and completes a Medical History Disclosure (MHD). Information provided during registration includes name, address, contact information, dependents and billing information. Spouses and dependents over age 18 will also be required to set up an account/register before requesting a consultation.Notes: The account set up and MHD can be completed any time after the welcome kit is received; however, it must be completed prior to receiving any consultation. When registering via telephone, Teladoc will read a HIPAA required statement and get a verbal agreement from the member.To request a consultation, eligible members contact Teladoc at:1-800-Teladoc, , or via the Teladoc mobile appNotes: A pre-cert is not required for Teladoc services.Scheduled times cannot be scheduled within an hourTeladoc will make 3 attempts to contact the patient. If they cannot get through, the consultation will be cancelled (the member will not be charged).Anonymous call blocker must be disabled in order to assure Teladoc can call the member for the requested appointment.The member talks with a physician. The consult is via phone, online or video. The consultation type availability depends on where the member is calling from. The physician is licensed in the state where the member is calling from.Prescriptions are allowed with telemedicine services and can include one refill for a maintenance prescription for up to 30 days. Exceptions to the prescriptions include: Georgia has a rule to issue prescriptions for no longer than 3 days for telephone consultations. If the physician believes 3 days is not sufficient, they will recommend the patient see a doctor in an office or emergency room.Teladoc physicians cannot prescribe DEA controlled substances or lifestyle drugsTeladoc physicians do not issue refills for prescriptions issued for a Teladoc diagnosis.If a prescription is prescribed, the drug card or Price Assurance program is utilized.Teladoc will refer the patient to an appropriate provider if the condition is chronic or serious in nature. The medical record can be sent to the member’s primary care physician.The member pays Teladoc the copay/deductible amount, up to $45, with their credit card at the time of the consult. For additional information regarding the patient responsibility, refer to the Consult Fee and Patient Responsibility section.Notes: Teladoc receives Real Time Eligibility (RTE) to assure accurate eligibility and available benefits (including out-of-pocket information) at the time of the consult.Once the member’s out-of-pocket is met, the member will not be charged the copay amount.Teladoc accepts all major credit cards (VISA, MasterCard, Discover, AMEX), PayPal and FSA/HSA forms of paymentTeladoc submits the claim electronically to Trustmark with Teladoc’s tax identification number of 20-1020949. This Tax ID will not be sent to the Aetna portal or any other repricing network (M1 logic will be bypassed).Trustmark processes the claim. Processing notes:Teladoc claims are processed as in-network. The claims are not subject to R&C or network discounts.The Type of Service is PFT (Applicable CPT codes are 99441, 99442 and 99443)The payee is TeladocTeladoc does not identify work related injury or illnessConsult Fee and Patient ResponsibilityThe consult fee will be $45 regardless of the procedure code billed.? The bill is received with the consultation procedure code and the $45 fee?from Teladoc as an electronic claim. The patient responsibility amount varies depending on the type of plan, plan copay amount and whether the patient has met their OOP or not:PPO Plan – Lesser of the in-network physician office copay or the full $45 charge. Examples:The charge is $45 with a plan copay of $20. The member will be charged $20 and the remaining $25 will be paid under the plan.The charge is $45 with a plan copay of $45. The member will be charged $45.The copayment will accumulate toward the in-network deductible and OOP max.CDHP Plan – $45 (The $45 is subject to deductible/coinsurance until out-of-pocket maximum is met)Customer Service CallerCall ReasonResponseEmployee“Is telemedicine / video conferencing covered under my plan?”Review the state of location for the group and member residence. If the group is located in or member resides in Arkansas, telemedicine services are not covered.If the group/member is not located in Arkansas, review the group effective/renewal date. If the group effective/renewal date is 07/01/2015 or later, then the plan has Teladoc. Advise the caller telemedicine services are covered.Note: Telemedicine is only covered if Teladoc is used. It is not covered under any other telemedicine vendor.EmployeeI was unable to complete my Teladoc consultationORTeladoc is telling me that I am not eligible“We will send this to Teladoc to be investigated. I just need some information to help them investigate it.First and last name of the patient (Use proper first name, no nicknames)Patient’s date of birthUMI from the ID cardDate and time of day (morning, afternoon, etc.) Teladoc was contactedPhone number used to contact Teladoc”Put all this information in an email to the Client Service Team at clientservices@ with a cc: to Angela Paret. The Client Service Team will investigate the issue.The Client Service Team can also be contacted at 800-509-8954BrokerThe member was unable to complete the Teladoc consultationEmployeeAny Teladoc related question or topicCallers can be transferred to the Teladoc call center at 1-800-TELADOC (1-800-835-2362) Important: When transferring a caller, please provide the member name and DOB before connecting the member.To avoid the IVR prompts and go directly to a Teladoc representative, Trustmark can transfer a caller directly to 540-316-9193. ***For internal use only; give the caller Teladoc’s 800 number, but transfer using this 540 phone number*** ................
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